Healthcare Provider Details

I. General information

NPI: 1871425793
Provider Name (Legal Business Name): JILL WASHINGTON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 KILLEARN CENTER BLVD APT E101
TALLAHASSEE FL
32309-3526
US

IV. Provider business mailing address

538 GARDEN VIEW CT
LAWRENCEVILLE GA
30046-3184
US

V. Phone/Fax

Practice location:
  • Phone: 321-332-3882
  • Fax:
Mailing address:
  • Phone: 321-332-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: